ABSTRACT
Serotonergic medications are used for the prevention and treatment of depression during pregnancy. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (SNRIs) can cause poor neonatal adaptation, which has been attributed to withdrawal versus toxicity. Bupropion, a norepinephrine-dopamine reuptake inhibitor, is often used as an adjunctive agent to selective serotonin reuptake inhibitors or SNRIs for refractory depression. Quetiapine, an atypical antipsychotic, may also be used in more complex cases. When combined with serotonergic drugs, bupropion and quetiapine are associated with increased risk of serotonin syndrome in adults. We describe a neonate exposed to venlafaxine (an SNRI), bupropion, and quetiapine in utero who presented nearly immediately after birth with encephalopathy and abnormal movements. The severity and rapidity of symptoms may be attributable to potentiation of venlafaxine's serotonergic effects by bupropion and quetiapine. Neonatal providers should be aware of maternal medications and prepare for possible adverse effects, particularly from common psychotropic exposures.
Subject(s)
Antidepressive Agents/adverse effects , Bipolar Disorder/drug therapy , Brain Diseases/chemically induced , Dyskinesia, Drug-Induced/etiology , Neurotransmitter Uptake Inhibitors/adverse effects , Pregnancy Complications/drug therapy , Stress Disorders, Post-Traumatic/drug therapy , Antidepressive Agents/therapeutic use , Brain Diseases/congenital , Brain Diseases/diagnosis , Bupropion/adverse effects , Bupropion/therapeutic use , Drug Therapy, Combination , Dyskinesia, Drug-Induced/congenital , Dyskinesia, Drug-Induced/diagnosis , Female , Humans , Infant, Newborn , Male , Neurotransmitter Uptake Inhibitors/therapeutic use , Pregnancy , Quetiapine Fumarate/adverse effects , Quetiapine Fumarate/therapeutic use , Venlafaxine Hydrochloride/adverse effects , Venlafaxine Hydrochloride/therapeutic useABSTRACT
Withdrawal emergent syndrome (WES) is a subtype of tardive dyskinesia that has been reported in children who were taken off antipsychotic therapy. We present the first case of WES in an infant born to a mother taking haloperidol during her pregnancy. The infant developed repeated tongue thrust, abnormal hand posturing, and tremor of all extremities. Most symptoms resolved within several days, but tongue thrust continued until 6 months of age.
